acromegaly Flashcards
define acromegaly?
constellation of signs and symptoms caused by hypersecretion of GH in adults
what is excess GH in children called?
gigantism
what is the main cause of acromegaly?
GH-secreting pituitary adenoma
what sometimes causes acromegaly?
ectopic GHRH or GH production from tumours
what is the epidemiology of acromegaly?
RARE
ages 40-50
what are the presenting symptoms of acromegaly?
- onset is gradual • Rings and shoes becoming tight • Increased sweating and oily skin caused by sweat gland hypertrophy • Features of a pituitary tumour = o Hypopituitarism o Headaches o Bitemporal hemianopia • Raised prolactin o galactorrhoea
signs of acromegaly on the hands?
o Large spade-like hands
o Thick greasy skin
o Carpel tunnel syndrome signs
o Premature osteoarthritis
signs of acromegaly on the face?
o Prominent eyebrow ridge o Prominent cheeks o Broad nose bridge o Prominent nasolabial folds o Thick lips o Increased gap between teeth o Large tongue o Prognathism o Husky resonant voice
what visual changes might there be?
o Bitemporal hemianopia
what changes might there be in the neck?
o Multinodular goitre
what might happen to the feet?
o Enlarged
what is the first line investigation for acromegaly?
- Serum IGF-1
- this is because GH stimulates IGF-1 secretion
what is the confirmatory investigation for acromegaly?
Oral Glucose Tolerance Test
75g of oral glucose
what other investigations might be done?
- pituitary function tests
- MRI of the brain
first line treatment for acromegaly?
trans-sphenoidal surgery is FIRST LINE
what might be the first line medical treatment of acromegaly?
how does this work?
Somatostatin Analogues
eg. octreotide
• Directly inhibits the release of growth hormone
what might be the medical treatment of prolactinomas?
o Oral Dopamine Agonists
bromocriptine, cabergoline
how do GH antagonists work?
• Prevents the dimerization of the GH receptor
how can acromegaly be monitored?
• GH and IGF1 levels can be used to monitor disease control
what are the CVS complications of acromegaly?
o Cardiomegaly o Hypertension o cardiomyopathy o left ventricular hypertrophy o arrhythmia
what are the resp complications of acromegaly?
o Obstructive sleep apnoea
what are the GI complications of acromegaly?
o Colonic polyps
what are the reproductive complications of acromegaly?
o Hyperprolactinaemia
what are the metabolic complications of acromegaly?
o Hypercalcaemia o Hyperphosphataemia o Renal stones o Diabetes mellitus o Hypertriglyceridaemia
what are the psychological complications of acromegaly?
o Depression
prognosis for patients with acromegaly?
- GOOD with early diagnosis and treatment
* Physical changes are irreversible
